Biden says the Obama administration will lay out a bold and contentious health care plan

Biden: Health care bill to be bold, contentious

WASHINGTON — Vice President Joe Biden said Thursday the Obama administration is fiercely determined to get a health care overhaul, although he conceded it likely won’t happen without “an awful lot of screaming and hollering.”

Appearing at a Brookings Institution gathering, Biden said it will be difficult to find a consensus on remaking the health care system. But he also predicted that “we’re going to get something substantial” and said he believes “we’re going to get there.”

Biden spoke as President Barack Obama continued a pre-Labor Day rest at Camp David. Obama is shifting his push for health care changes into high gear next week with a State of the Union-style address to a joint meeting of Congress.

The vice president suggested Obama will tell Congress and the American people precisely what he thinks must be included in the package that the White House is pressing lawmakers to approve this fall.

Obama’s scheduled speech next Wednesday is in no small part a bid to salvage his health initiative in the face of withering attacks from Republicans, interest groups and many private citizens.

Biden did not say whether the screaming would come from liberals who feel Obama is accepting too many compromises, or from conservatives and moderates who feel his plan costs too much and threatens the health of private insurance companies.

Biden said he would not provide details of the scheduled speech, but he said Obama will lay out the main options for a health care overhaul and “what he thinks those pieces have to be and will be.”

The president’s speech will come a day after lawmakers return from their August recess. It underscores the White House’s determination to confront critics of Obama’s overhaul proposals and to buck up supporters who have been thrown on the defensive. Allies have been urging Obama to be more specific about his plans and to take a greater role in the debate.

The speech’s timing also suggests that top Democrats have all but given up hope for a bipartisan breakthrough by Senate Finance Committee negotiators. The White House had given those six lawmakers until Sept. 15 to draft a plan, but next week’s speech comes well ahead of that deadline.

It follows an August recess in which critics of Obama’s health proposals dominated many public forums. Approval ratings for Obama, and for his health care proposals, dropped during the month.

White House senior adviser David Axelrod told reporters Wednesday, “We believe this is the best way to kick off the final discussions, the final debate, and bring this thing to a close in a way that is meaningful.”

Many advocates of sweeping health care changes — which would include health coverage for virtually every American, greater competition among insurers and incentives to increase the quality of care instead of the number of medical procedures performed — welcomed the president’s more direct role in the debate.

Obama and congressional Democrats clearly lost momentum during the August recess, they say, and the president’s high profile and still-considerable personal popularity are needed to change the dynamic.

“He’s got to get into the nitty-gritty and embrace very concrete proposals,” said Ralph Neas, head of the National Coalition on Health Care.

Republicans fiercely oppose creation of a government-run plan, and the White House has been talking directly with Sen. Olympia Snowe, a moderate Republican from Maine, who has proposed an alternative.

Snowe’s idea is to use the threat of a government plan to force private insurers to become more competitive and cost conscious. She has been advocating the approach for months in closed-door negotiations with fellow senators and in talks with White House aides and the president.

The precise details have yet to be worked out, but the general idea is to give the insurance industry a fixed time to show that it can stem rising medical costs. If the private carriers fail, the government-run plan would be created. The approach could be tailored so that the government plan is used only in areas of the country where one or two private insurers control the market and have failed to bring down costs.

But the government plan wouldn’t have to be used in regions where consumers have a choice of insurance companies and competition has kept prices low.

However, liberals are wary of Snowe’s plan, favoring a robust government-run plan.

Several lawmakers say Obama must convincingly show that he can reduce the cost of pending health care plans. Obama’s proposals could cost about $1 trillion over the next decade, but proposed cost savings elsewhere and tax increases could offset most or all of that.

In one measure of the intense opposition Obama and his allies faced this summer, opponents of the Democratic effort outspent supporters on television commercials in August for the first time this year, according to a company that monitors political advertising.

Associated Press writers Ricardo Alonso-Zaldivar, Alan Fram and Ben Feller in Washington, Mike Glover in Iowa, and Mead Gruver in Wyoming contributed to this report.

(This version CORRECTS cost estimates in paragraph 20 to note that higher costs might be offset.)